HWN Suggests

Posterior Hip Dislocation

Although posterior hip dislocation is an uncommon injury, the consequences of delayed recognition or treatment can be dire. The majority are caused by head-on car crashes, and 90% of these are posterior dislocations. The femoral head is forced across the back wall of the acetabulum, either by the knee striking the dash, or by forces moving up the leg when the knee is locked. This occurs most commonly on the right side when the driver is standing on the brake pedal, desperately trying to stop.

On exam, the patient presents with the hip flexed, internally rotated and somewhat adducted. Range of motion is limited, and increasing resistance is felt when you try to move it out of position.…

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Featured

  Novel Hip Reducution Technique: The Captain Morgan

In the Captain Morgan technique, the patient is left in their usual supine position and the pelvis is fixed to the table using a strap (call your OR to find one). The dislocated hip and the knee are both flexed to 90 degrees. The physician places their foot on the table with their knee behind the patient’s knee. Gentle downward force is placed on the patient’s ankle to keep the knee in flexion, and the physician then pushes down with their own foot, raising their calf. Gentle rotation of the patient’s hip while applying this upward traction behind the patient’s knee usually results in reduction.

  Allis maneuver

Video presentation for most common procedure.

  Core EM

Urgent reduction (<6 hours) should be performed in most cases to reduce the risk of osteonecrosis.

  EMrap

Multiple techniques for reducing a posterior hip dislocation are demonstrated by orthopedic surgeon Dr. Stewart Kerr and emergency physicians Drs. Jessica Mason and Whitney Johnson.

Articles of Interest

Field Assessment & Treatment of Posterior Hip Dislocations

Posterior hip dislocations are increasing along with the popularity of extreme sports; one study indicated that snowboarders were more likely to suffer a posterior hip dislocation than skiers.

Novel Hip Reduction Technique: The Captain Morgan

Named after the pose of the trademark pirate for Captain Morgan rum, this technique simplifies the task of pulling the hip back into position. One of the disadvantages of the standard technique is that it takes a fair amount of strength (and patient sedation) to reduce the hip. If the physician is small or the patient is big, the technique may fail. In the Captain Morgan technique, the patient is left in their usual supine position and the pelvis is fixed to the table using a strap (call your OR to find one). T

Pediatric Traumatic Hip Dislocation

It doesn’t have to be a car accident! Low force mechanisms can lead to hip dislocations in young children.

Resources

WikEM

Hip prosthetic dislocation is more common and less emergent.

American Medical Forensic Specialists

Direct force trauma (minor or major force) to the thigh is the most common cause of hip dislocation. Hip dislocation can also be caused by congenital condition and acetabular or femoral head dysplasia. Greater force is required to dislocate an adult’s hip than a child’s hip. Motor vehicle accidents (MVAs) and falls are the common causes of hip dislocation. Children may have a hip dislocation due to relatively minor trauma. Prosthetic hips can dislocate as well, particularly as they age, or as a consequence of improper surgery or rehabilitation.